Pneumonia community acquired

There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

Patel T, Pearl J, Williams J, Haverstock D, Church D. Efficacy and safety of ten day moxifloxacin 400 mg once daily in the treatment of patients with community-acquired pneumonia. Community Acquired Pneumonia Study Group. Respir Med 2000 94(2) 97-105. 

Pneumonia—Community-acquired bacterial pneumonia is frequently caused by Streptococcus pneumoniae (pneumococci). In the United States, more than 15% of recent isolates of S. pneumoniae are highly resistant to penicillin and increasingly resistant to cephalosporins, macrolides, and less commonly to fluoroquinolones. Other bacterial pathogens include Haemophilus influenzae. Staphylococcus aureus, Klebsiella pneumoniae, and, occasionally, other Gramnegative bacilli and anaerobic mouth organisms. Atypical ... 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

Recognizing the presumed site of infection and most common pathogens associated with the infectious source should guide antimicrobial choice, dose, and route of administration. For example, community-acquired pneumonia is caused most commonly by S. pneumoniae, E. coli is the primary cause of uncomplicated UTIs, and staphylococci and streptococci are implicated most frequently in skin and skin-structure infections (e.g., cellulitis). 

List the common pathogens that cause community-acquired pneumonia, aspiration pneumonia, ventilator-associated pneumonia (early versus late onset), and health care-associated pneumonia. 

Recognize the signs and symptoms associated with community-acquired pneumonia and ventilator-associated pneumonia. 

Design an appropriate empirical antimicrobial regimen based on patient-specific data for an individual with community-acquired pneumonia, aspiration pneumonia, and ventilator-... 

Streptococcus pneumoniae is the most common bacterial pathogen associated with community-acquired pneumonia. 

Treatment of community-acquired pneumonia is predominantly empirical. 

Presentation of Severe Community-Acquired or Aspiration Pneumonia... 

In approximately 10% of patients, community-acquired pneumonia will be severe enough to require intensive care or mechanical ventilation. 

As stated in the clinical presentation of community-acquired or aspiration pneumonia. 

TABLE 68-3. Summary of Community-Acquired Pneumonia Treatment... 

Ayjesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005 118 384-392. 

Barlow GD, Lamping DL, Davey PG, et al. Evaluation of outcomes in community-acquired pneumonia A guide for patients, physicians, and policymakers. Lancet Infect Dis 2003 3 476-488. 

Man dell LA, Bartlett IG, Dowell SF, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003 37 1405-1433. 

Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001 163 1730-1754. 

Community-acquired pneumonia Health care-associated, ventilator-asociated, or nosocomial pneumonia (Early onset no risk factors for MDR pathogens) Third-generation cephalosporin plus a macrolide or doxycycline Third-generation cephalosporin OR Fluoroquinolone OR Ampicillin-sulbactam OR Ertapenem... 

Methicillin-resistant Staphylococcus aureus (MRSA) is a common hospital-acquired pathogen and is also increasing in the community. MRSA has presented a problem in the past because it required treatment with vancomycin. Community-acquired MRSA presents a major therapeutic challenge. MRSA can cause pneumonia, cellulitis, and other infections. Clinicians should be aware of the rate of hospital and community MRSA in your geographic area. New treatment options are available for MRSA. They include linezolid, tigecycline, and daptomycin. Prospective clinical trials have not demonstrated benefits of these agents over vancomycin.36-37... 

Streptococcus pneumoniae is the most common bacterial cause of community-acquired respiratory tract infections. S. pneumoniae causes approximately 3000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and over 1 million cases of otitis media each year. The increasing prevalence of drug-resistant S. pneumoniae has highlighted the need to prevent infection through vaccination. Both licensed pneumococcal vaccines are highly effective in preventing disease from the common S. pneumoniae serotypes that cause human disease. 

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission on Accreditation of Healthcare Organizations has also incorporated these standards into their accreditation reviews of health care facilities. 

The vast majority of pneumonia cases acquired in the community by otherwise healthy adults are due to S. pneumoniae (pneumococcus) (up to 75% of all acute bacterial pneumonias in the United States). Other common bacterial causes include M. pneumoniae, Legionella, and C. pneumoniae, which are referred to as atypical pathogens. Community-acquired... 

Empirical Treatment for Suspected Bacterial Community-Acquired Pneumonia (CAP)... 

Drugs recommended for empiric treatment of community-acquired pneumonia are presented in Table 43-9. 

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